Background: Although surgery has emerged as the primary treatment of choice for endometrial carcinoma, the optimal sequencing of adjuvant multimodal treatment for advanced stages III-IV disease continues to be unresolved. Objectives: To determine the efficacy and safety of different sequencing of multimodal adjuvant treatment using chemotherapy and radiotherapy for advanced endometrial cancer. Methods: A retrospective cohort study on patients diagnosed with FIGO Stage III-IV endometrial cancer seen at the Cancer Institute of Philippine General Hospital from 1997 to 2004 was done. Data on pitient characteristics, surgical procedures performed, histopathology, types and duration of adjuvant treatments, toxicities and disease status were collected and recorded. Cases were categorized according to the sequence of multimodal adjuvant treatments received: Arm I - Radiotherapy followed by chemotherapy, Arm II - Radiotherapy "sandwiched" between chemotherapy sessions, and Arm III - Chemotherapy then radiotherapy. Primary endpoint was disease-free duration. Result: A total of 43 cases were included in the study. Twenty-seven (62.79 percent) underwent radiotherapy followed by chemotherapy (Arm I), 15 (34.88 percent) received adjuvant chemo-radiation therapy in which the radiotherapy component was variably scheduled in between chemotherapy sessions (Arm II - sandwich therapy). There was only 1 patient (2.33 percent) who underwent chemotherapy followed by radiotherapy (Arm III). Only data on blood and bone marrow toxicities were available for analysis. Grade 3 anemia was documented in only one case in Arm II. Grade 4 leukopenia was seen in only one patient in Arm I. Mean disease-free duration for the Arm I was 95.7 months (95 percent Cl; 86.06 - 105.34) compared to 90.5 months (95 percent Cl; 77.86 - 103.13)for the Arm ll (p = 0.89). Conclusion: No statistically significant difference in disease-free duration was noted between sequential treatment with radiotherapy then chemotherapy and the sandwich therapy. Both treatment strategies were tolerated well with minimal grade 3 or 4 toxicity. (Author)
Endometrial Carcinoma ; Brachytherapy ; Cisplatin ; Doxorubicin ; Adjuvant Drug Therapy